No doubt about it, technology has significant impact in making the job of neurosurgeons easier and with more precision. Aside from the new instruments and equipment used for minimally invasive surgical procedures in neurosurgery, new technology now gives real-time images in the surgical room for the neurosurgeons to refer to during the procedure.
Just like the case in most video games, the player’s task is to maneuver the video game character through mazes or dungeons or tunnels to rescue the princess. In neurosurgery, the neurosurgeon’s task is to maneuver the tiny instruments through gelatin-like surfaces to remove a hidden tumor or mass.
Unfortunately, in neurosurgical procedures before, the surgeon cannot actually see the tumor or mass but only through X-rays, which do not present real-time images from the time the X-ray was taken.
Imaging Systems in Surgery
For neurosurgeons, it is critical to see actual images of the brain during the procedure of say, removing a tumor as real-time image will point the exact location they need to target to take out the tumor. Within the past ten years, imaging systems have improved tremendously to provide much clearer pictures of the brain’s structures.
And through efficient navigational tools, neurosurgeons are assisted to map direct approaches to minimize entry points and preserve the healthy brain and its functions. However, the effectiveness of even the most detailed images has its limitations stemming from the fact that brain matter moves so a picture taken no longer capture the most recent movement.
This need prompted those involved in neurosurgical procedures to attempt to install large machines in surgical rooms that will take advantage of MRI technology. Unfortunately, strong and powerful magnetic fields tend to defeat the attempt as such magnetic fields interfere with instrumentation.
Other electronic equipment in the operating room causes the distortion of the images, and the shape and enormity of the machines made them quite space consuming and therefore impractical for use during surgery.
In some hospitals, large machines are located adjacent to surgical suites, but it would require transporting surgery patients back and forth to and from the MRI room and the surgery room. This process could be very costly in terms of time and efficiency and may cause some really serious problems with respect to surgery outcome.
Intraoperative MRI or iMRI Technology
Technology has improved MRI for utilization of neurosurgeons in obtaining update images in the surgical room with real-time results. Intraoperative MRI or iMRI technology is the latest generation real-time imaging system that most hospitals across the country are installing in their operating rooms.
LSU Health Center
The LSU Health Center in Louisiana, for example opened their Neuro Interventional Radiology Suite in 2007 giving its residents the chance to learn about less invasive surgical procedures for diagnosing and treating blood vessels of the spine, neck and head disorders.
This neurosurgery suite provides high quality digital fluoroscopy, real-time 3-dimensional angiography and 3-dimensional road mapping that allows improved treatment planning and the ability to navigate catheters and wires directly on the 3-D images. For neurosurgeons in Louisiana, this improved imaging helps obtain CT-scan like images which can help detect any sign of material swelling, bleeding or growth of hydrocephalus without the need to leave the operating room.
For LSU Health Center and the many other hospitals across the country, multimodality integration, advanced interventional tools and more importantly, image quality are just indispensable.
Other Neurosurgical Centers
Other leading neurosurgical centers in Louisiana are using compact iMRI system that can be stored under the operating table and used only when needed, often, once before the procedure and another at the end. The adoption of such iMRI system resolves most of the surgical problems encountered in the past.
The machine’s compact size, portability and tightly contained magnetic field, the neurosurgery team will experience less electronic interference, has direct access to the patient and allows the use of various surgical instruments without causing any problem on the functions. For hospitals that want to adapt the system, they will have to retrofit their existing surgical facilities.
Benefits of Real-Time Images for Neurosurgeons and Patients
It is important for neurosurgeons to have real-time images during surgery as it will enable them to alter approaches depending on the presenting conditions viewed from the images, allowing them to obtain a high level of precision in what they’re doing. This makes the minimally-invasive procedure beyond minimal.
The high resolution and update images allow them to see the tumor or injury or deformity in the brain with greater clarity which will assist them in precisely locating the target for removal without causing damage or harm to otherwise healthy tissues. This imaging technology significantly increases the percentage of completely removing the tumor.
The benefits for patients translate into shorter recovery period, shorter hospitalization, better surgery outcome and reduced need for follow-up surgery. With intraoperative MRI, neurosurgeons are able to visually locate exactly where a tumor is located and when removed, the images can show if any of the tumor remains in the area.
Without the imaging system, the patient runs the risk of growing back the tumor after some time because it was not completely remove during the first surgery. With neurosurgeons actually seeing the condition and status of the brain and its surroundings, follow up surgeries will no longer be required because the first surgery should have accomplished complete removal of the tumor or addressed other problems.
3D Camera (Endoscope) Used to Remove Brain Tumor
A Toronto doctor made the headline in October 2012 when he inserted a 3-dimensional camera up the nose of a 75-year old man which led the neurosurgeon to remove a benign but walnut-sized tumor on the pituitary gland at the base of his skull. The tumor was apparently pressing on the patient’s optic nerves causing loss of vision.
The 3D camera no larger than a speck of sand was attached to an endoscope which was buried about 10 centimeters in the nose and brain of the patient, providing the neurosurgeon with clear image that guided him in the precise resectioning of the tumor. With the 3D tool, the neurosurgeon was able to maneuver the instrument precisely even in a limited and tiny space. The tumor is removed with reduced risk of error and unnecessary damage.
The use of 3D endoscope has already been approved by the US FDA and a number of hospitals are using the technology. The same 3D technology is widely used in Italy, European and Israel hospitals.